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Sweet Success

We may have conquered smallpox and polio, but new killers have surfaced -- and diabetes is one of the worst of them
A Sanofi app for managing diabetes. (photo credit: Courtesy)
A Sanofi app for managing diabetes. (photo credit: Courtesy)

It seems that medicine follows the principle of “two steps forward, one step back”. As miracles happen every day in terms of new technologies and medications, we are now facing a new epidemic unlike others that have plagued humankind in the past. Whereas diseases like measles and polio are, for most of the world, forgotten horrors, we now face an insidious disease that eats away at the world’s health.

I am not being dramatic when I speak of Diabetes as a plague and as a terrifying disease. While human beings tend to benefit from the amazing capacity to adapt to a slow negative influence, in the case of Diabetes, most people fail to appreciate just how dangerous it is because of its relatively slow progression.

I should clarify that there are various ways to classify Diabetes. One way relates to whether the patient requires insulin to manage blood levels of sugar [or more appropriately called, glucose]. Another way to classify Diabetes relates to how the human body responds to Insulin, whether it is produced internally by the organ called the pancreas or whether the Insulin is given externally. For some people, they suffer from Insulin resistance. This means is that even though they may have enough Insulin in their blood, their own body’s cells are unable to recognize the Insulin.  Imagine the not so uncommon scenario of forgetting where you parked your car. You know it is out there but you can’t see it or find it. Similarly, one possible characteristic of Diabetes is that our bodies cannot “see” Insulin. Finally, there are cases where our bodies fail to produce any Insulin versus cases where Insulin levels are very high. Without going into any more detail about the medical classification of Diabetes, let me just say that it is important for a physician to fully classify a patient’s Diabetes before starting care.

Just as a person with high blood pressure can track the success of their anti-hypertensive medication by measuring their blood pressure, so a diabetic can measure their success in treatment by measuring their levels of glucose in the blood. The most common way to do this is by making a small puncture at the tip of a finger and applying the resulting drop of blood to a glucose measuring device, called a glucometer. Since many patients must check their glucose levels multiple times a day, it should already be clear how uncomfortable and simply annoying all of these punctures can be. It is for this reason that medical researchers have been looking for noninvasive alternatives to the classic means of measuring blood glucose.

Recently, Google has described a new technology that may revolutionize how blood glucose is measured. The technology involves a “smart lens” with non-invasive sensors and miniaturized electronics that will (a) measure glucose levels in the eye’s tears and (b) improve vision. The measured glucose levels will be transmitted, at least in the first phase, to the person’s smartphone. It is reasonable to expect that additional software will not only record these values and track them over time, but will also offer recommendations for treatment and perhaps most importantly, notify important contacts and the patient’s physician in the event that the patient’s Diabetes is out of control.

Just a few years ago, this kind of technology was truly considered science fiction and the stuff of movies. In a few years from now, such noninvasive sensors may be second nature to most of us. The idea of constantly being monitored scares many people.  But I imagine that most people would agree that  this kind of glucose monitoring is worth the potential loss of privacy that comes with constant monitoring not just of glucose, but of one’s location [so that emergency care givers can know where to go in the event the diabetic gets into trouble]. Considering the number of diabetics in the world, which is huge and only growing, it will not be long before most people are being tracked. Other people will be tracked for their blood pressure or for their abnormal rhythms of the hearts or for early signs of a heart attack and stroke and more. And I imagine that most of these individuals will not even mind that their privacy has been invaded, given the benefits of this constant monitoring.

I hope that physicians embrace these kinds of new technologies as they hit the market. I think that a critical role for physicians would be to explain these technologies to their patients and to reassure their patients that the benefits are tremendous and worthwhile even at the loss of some privacy. I can easily see physicians playing such a role in the coming decades – being a liaison between the grand new world of technology and the individual patient. Physicians can be a human face to the metallic covers of technology. I personally believe that physicians plus technology is an unstoppable pair. Admittedly, I also believe that technology will eventually be able to provide all that a human physician  can give. But that will take time. And in the meantime, physicians will still have a very important role to play

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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